The Astringent Quality of Point Baihui Du-20

A case history analysis originally published in the Journal of Chinese Medicine in England

Introduction

The following is a case history of a 38 year old woman who had suffered for four years
from ulcerative colitis. The use of point Baihui DU-20, in her case, brought about
a full recovery of all symptoms associated with this disease. It is quite rare in
acupuncture therapy to achieve a full recovery, especially from a stubborn and
hard-to-cure disease, by the use of a mere point in a prescription. However, in this case
I had no doubt (nor did the patient) that the use of this point was the turning point of
the treatment.

Case History

Mrs. H, aged 38, was diagnosed four years prior to her visit to my clinic as having
ulcerative colitis. Two years before the diagnosis was established, she started suffering
from frequent bowel movements accompanied by heavy bleeding, pus and pain. She was sent to
Nahariya Hospital where she had several tests, and where, after two years, was given this
diagnosis.

Ulcerative colitis is a chronic, non-specific, inflammatory and ulcerative disease of
the colon, characterized most often by bloody diarrhea. The disease usually begins in the
rectosigmoid area and may extend proximally, eventually involving the entire colon, or it
may attack most of the large bowel at once. Most often an attack begins insidiously with
an increased urgency to defecate, mild lower abdominal cramps, and the appearance of blood
and pus in the stools.

According to TCM the large intestine is a Fu organ belonging to the digestive system,
and its function is mainly to transport the residues of the digested food to the anus for
excretion. Its work is dependent mostly on the spleen, which is the Zang responsible for
the Yun Hua activity of the digestive system, i.e. transformation and transportation of
solid and fluid food.

Diseases of the large intestine may be of internal or external origin. They may be
caused by internal imbalances of the digestive system such as ST-Qi or SP-Yang Xu, or by
LIV-Qi interfering with the Spleen's activities by 'invasion'. These diseases may involve
many different digestive problems, besides that of the large intestine. External inflicted
diseases of the large intestine are bound to happen due to the fact that this organ is a
Fu, a 'hollow' organ which is in close relation with possible external pathogens e.g.
food, water, poison etc. External diseases of the large intestine have a more sudden
onset, and usually most of the main symptoms are related to the pathology of this organ
itself. Still, by virtue of the large intestine's functional relationship to the Spleen
and Stomach, a long enough duration of a large intestine disease may harm the
transportation-transformation activities of the Spleen. It may also involve the Spleen's
function of 'holding the blood', or even the Spleen's function of 'holding the organs and
tissues' in place. In these cases there might be chronic bleeding, hemorrhoids, rectal
prolapse and other diseases.

Among the symptoms that Mrs. H. exhibited were the following: cramps and pain in her
lower abdomen, belching and flatulence, heartburn, dry and itchy eyes. She would sometimes
feel weak and dizzy, but most of the time she felt energetic and strong. She also
suffered, lately, from sacral-region pain. She did not have gynecological problems, her
periods came on time, and each one lasted 5 days. Mrs. H. had been pregnant four times.
She had three children and one artificial abortion.

Physical examination revealed a slim, energetic woman, somewhat nervous, who spoke
quickly. Her pulse was rapid (96 on first examination), deep, thin and soggy. In the right
Guan position it had a wiry quality as well, and felt more elevated. The tongue was
basically pale with somewhat redder edges, covered with slippery yellowish moss.

On palpation of the abdomen I found the descending colon very tender, as well as the
epigastric region. The Front-Mu point of the Kidney (Jingmen GB-25) on the left side was
also tender, as well as both Front-Mu points of the Liver (Qimen LIV-14).

In accordance with the findings described above, the diagnosis was a Damp Heat invasion
of the Large Intestine. The Heat caused the bleeding and the irritation of the inner
mucosa of the colon, which in turn caused the frequent peristalsis and the diarrhea. The
long duration of bleeding caused a depletion of blood and yin which showed itself in the
heartburn, dry eyes and dizziness, as well as the pale tongue and thin submerged pulse.
The abundance of Damp showed itself by the slippery yellowish moss.

The treatment was constructed of two phases:

Eliminate the Shi symptoms, i.e. heavy bleeding, Damp and diarrhea.

Strengthen constitutional weakness, repair internal damage.

The points were:

Hegu L.I.-4

Zhongwan REN-12

Dachangshu BL-25

Tianshu ST-25

Shangjuxu ST-37

Yinlingquan SP-9

Zusanli ST-36

Sanyinjiao SP-6

Hegu L.I.-4 is the Yuan point of the large intestine. Yuan points deal directly
with their associated organs. This point was reduced by rotation and lifting and thrusting
manipulation. Dachangshu BL-25 and Tianshu ST-25 were chosen in accordance
with the principle of combining Front-Mu and Back-Shu points - to regulate the function of
the large Intestine. Shangjuxu ST-37 is the lower He-Sea point of the large
intestine and was reduced in order to clear Damp and Heat from that organ. Yinlingquan
SP-9 and Sanyinjiao SP-6 are famous for their mutual ability to clear Damp from
the digestive system, and hence treat diarrhea and pus in the stools. Zusanli ST-36
was chosen to strengthen the spleen in order to stop the bleeding, and help recreate yin
and blood. It was the only point which was tonified. Zhongwan REN-12 is the
confluent point of all the Fu and was manipulated evenly. After a course of 12 treatments,
3-4 times a week, the bowel frequency was greatly diminished, from 15 to 20 times a day to
3 to 4 times. There was much less gas and pain in the bowels, and there was very little
pus. However, there was only a small decrease of bleeding, which was still apparent. In
order to put a further emphasis on arresting the bleeding, the prescription was changed to
the following:

Yinbai SP-1

Geshu BL-17

Pishu BL-20

Guanyuanshu BL-24

Qihai REN-G

Tianshu ST-25

Zusanli ST-36

Yinlingquan

Yinbai SP-1 is effective to strengthen the SP and arrest bleeding (by direct
moxibustion). Geshu BL-17 the Hui point of blood was tonified. Pishu BL-20
the Back-Shu point of the spleen was tonified to strengthen the spleen function of
retaining the blood. Guanyuanshu BL-24 was treated by warming needle technique;
this point in concert with Qihai REN-6 arrests bleeding. Tianshu ST-25 was
also treated by warming needle technique. Zusanli ST-36 and Yinlingquan SP-9
remained intact.

The use of warm-needle technique was decided upon for two reasons:

This technique is renowned for its ability to resolve Damp and create blood.

Since the patient's condition showed no definite Heat signs at this stage, and the
submerged pulse indicated a weak yang Qi within the blood, it was decided to strengthen
the yang Qi by warming needle, and by this the astringent quality of the spleen.

This new formula showed itself effective, and after each treatment with moxa, there was
a remission of bleeding for one to three days. Along with this the other symptoms further
improved, the coating of the tongue subsided, and the bleeding was much less massive.

This new treatment pattern was carried on for about 1 5 sessions. At the end of this
course the patient had 1-2 daily bowel movements. Most of the previous symptoms were gone
except for bleeding in the stools, and slight light-headedness now And then.

At this stage I decided to further change the point prescription, as follows:

Sanyinjiao SP-6: tonified

Guanyuan REN-4: also tonified, to strengthen Yuan Qi, Kidney and constitution, and to
replenish blood.

Qihai REN-6 and Tianshu ST-25 by warm-needling.

This program was carried on for several weeks, twice a week, but the bleeding still
persisted. It is interesting to note that several attempts were made to give the treatment
without the burning of moxa on Tianshu ST-25, after which the usual two-day remission in
the bleeding did not occur.

At that point I decided (mainly by intuition, I suppose) to add Baihui DU-20 to
the prescription. Baihui (Hundred meetings') is a 'cross-road' point on the vertex,
belonging to the Du Mai channel. It is the meeting point of all the yang channels, and is
situated on the most yang part of the body. It has the function of strengthening yang and
elevating Qi. It is also known to raise the sinking Qi of the spleen. In accordance with
these qualities (among other qualities not discussed here) this point is largely used for
astringent purposes. Astringent purposes in TCM are disorders in which body fluids like
urine, diarrhea, sweat, blood etc. are discharged abnormally, and/or organs (uterus,
rectum etc.) slip, or sink, from their normal positions. I therefore punctured Baihui
DU-20 in a horizontal manner, 1 cun deep, in a posterior direction. The patient felt
rather a strong tingling sensation all over the top of her head, along with local pain and
distention. From that treatment on there was no recurrence of bleeding in the stools. The
patient carne to me thereafter for several months, once a month, to receive the same
treatment, and her condition remains unchanged.

Conclusion

The cessation of bleeding and restoration of complete normal functioning of the large
bowel was indeed dramatic after the application of point Baihui. The gradual improvement
of the patient's condition i.e. elimination of Shi symptoms first, and then restoration of
normal bowel functioning, proves that basically both the diagnosis and treatment were
applied correctly.

However one might wonder whether an earlier application of Baihui would have cured the
patient earlier. Still the main conclusion, in my opinion, is twofold:

Even though the diagnosis is perfect and the selection of points matches this diagnosis,
sometimes focusing on very well chosen points within the manifold possibilities of a given
pattern, can make the difference between a good treatment and an inspired one.

If ultimate resolution is not achieved, one should never hesitate to alter, add, or
reconsider the use of other points (or techniques), even though one is sure of the
diagnosis and choice of points.

Shmuel Halevi Ph.D. has practiced Chinese medicine in Israel since 1980.
He studied Chinese medicine in the U.S.A and in Taiwan, and obtained his Ph.D. degree in the U.S.A.

Shmuel has written many articles concerning Chinese medicine, in the past 20 years. Most of his articles have been published in the Journal of Chinese Medicine in England. He has also contributed a case-study article to the book: "Acupuncture In Practice " (Case history insights from the west - compiled by Ted Kaptchuk and Hugh MacPherson, Churchill Livingstone 1997).

Shmuel is the author of the book: Chopsticks Acupuncture (Trafford Publishing, B.C. Canada Jan. 2003). In this book he presents a totally new self-treatment technique by chopsticks, devised especially for the lay person.